'Drill and fill' culture to end as dentists paid to focus on prevention instead of cure

The 'drill and fill' culture among some dentists may soon be at an end as professionals are instead paid to prevent cavities.

As part of one of the biggest shake ups in modern dental work to date, more than 70 dentists have had their contract changed to reward them for focussing more on prevention and not treatment.

Until now, there have been no financial incentives for dentists to keep patients disease free. Under the new system, incentives are being awarded to dentists to prevent disease (called 'capitation').

Dentists give all patients an initial assessment on their oral health when they arrive for an appointment. The patient then gets a Red, Amber or Green (RAG) rating, which is used to produce a personalised plan of prevention. These RAG ratings are then reviewed at timely intervals, to see how a patient is progressing.

The RAG rating results are then discussed with the patient, with the dentist explaining any potential risks around tooth decay, gum disease and even cancer.

The new system has been tested since the start of 2016 and dentists are already reporting positive feedback from patients who previously waited until they were in pain before accessing services.

David Mowat, Minister for Community Health and Care, said:

By giving dentists the incentive to prioritise preventive work we will ensure that dentists can provide the best care and prevent problems from occurring in the first place.

Through dedicated work with patients and identifying risks early on, we can protect people's teeth, whilst saving valuable funds for the tax payer.

Dr Paul Worskett, a dentist at Amblecote Dental Care practice in Dudley, who is part of the programme, said

A great deal of dental treatment is avoidable because most dental disease is preventable. We need to make sure people have the right information so they can keep their mouths healthy and keep their teeth for as long as possible.

This system means that we are using our time more effectively and patients feel like they are getting a more personalised service. Most importantly, their mouths are getting healthier, often along with their general health.

Under the new contract, dentists can receive capitation payments for ongoing care for up to 80 per cent of their work, covering treatments such as check-ups and fillings. They then receive an additional payment for the remaining treatments such as crowns and bridges. This means that dentists are incentivised to carry out prevention. The current contract does not include capitation so dentists are only paid for the treatments they deliver.

Brierley Hill resident and patient Gary Marshall, 79, said:

They've been just great at the Brierley Hill surgery. I'm nearly 80- and they've gone out of their way to explain all sorts of things to me about mouth cancer and gum disease that I didn't know before. I couldn't be happier with the service, and I feel like I'm in good hands for the future.

The new system is being run until March 2018 and the government will evaluate results from dental practices in the pilot areas before deciding whether to extend the approach across the country by 2020.

Chief Dental Officer England Sara Hurley said:

This is good news for patients and our NHS. The proposed contract will allowNHS commissioned dental practices in England to provide far more personalised prevention programmes to meet the individual needs of all patients, helping to improve oral health across the country. Through reformed contacts we want to see an increase in the availability of dental appointments and wider access to quality care and advice dentists provide.

· Incentive payments to promote ongoing care (capitation payments) include things such as check-ups and additional payments for necessary treatments (activity) include things such as crowns and bridges.

· Around half of the 79 sites are testing 80% capitation and 20% activity. The other half are testing 60% capitation and 40% activity.